Few people understand employer-sponsored healthcare like Rob Paczkowski. He’s built his career leading employee benefits at Google, Capital One, and eBay, always focused on building a better experience for members.
Rob sat down with Eddie Chin, our Director of Product, to talk through what actually makes an experience great.
Tune in to learn:
- Why experience is what engages members in the first place, and keeps them coming back
- How human-guided navigation closes the gap between a list of names and a good doctor with an open appointment
- What he’s seen in practice: employees with a primary care doctor were 31% less expensive, risk-adjusted across nine major disease states. It’s why he’s focused on getting more members into good primary care, and sees advanced primary care as the next step
Resources
Rob Paczkowski's LinkedIn
Eddie Chin's LinkedIn
Handpicked Health's LinkedIn
Overview
00:00 Intro & Rob's 34 years in employee benefits
01:25 Why experience matters as much as cost/outcomes
01:57 NPS vs. real experience metrics (respect, shared decision-making, timely appointments)
05:52 Experience as investment, not cost
07:23 Case study: 31% savings from having any primary care doctor
09:36 Case study: subclinical stress coaching vs. clinical psychologists (25% savings)
12:07 Using smart defaults to reduce decision fatigue (401k analogy)
13:42 Where care navigation fits in
16:15 What is Advanced Primary Care (APC)?
18:44 Employee challenges finding the right doctor
20:40 The anxiety of navigating care + AI/Slack tools for guidance
24:28 Scaling personal guidance with AI ("cloning" Rob into a tool)
26:47 Virtual APCs: what works, and the human-touch gap
28:58 Closing thoughts: coordinated, not fragmented, care
29:26 Why storytelling & education matter for adoption
31:14 Public policy advocacy and misaligned incentives
32:57 Policy wins & priorities: Cadillac tax, transparency, One Big Beautiful Bill, RUC reform, PBM disclosures
36:02 Role of the Purchaser Business Group on Health (PBGH)
37:17 Closing remarks
Transcript
00:00 Eddie Chin: Today we are speaking with Rob, who has been working with employers to bring and manage the best benefits in the industry to employees and their families. He's been doing this for decades. How long have you been doing this great work, Rob?
00:23 Rob Paczkowski: It's hard to believe, but this is my thirty-fourth year of doing it full time, not counting my internships, as a benefits professional. And I've only worked on the corporate side of employee benefits; I've never done consulting or anything on the vendor side. So, pretty much a solid thirty-four years. Hard to believe.
00:43 Eddie Chin: With that, let me introduce Rob. We're friends, and we thought we'd have a conversation about experience within healthcare, something we're both passionate about. I can introduce Rob as an expert in the field because it's been three decades and plus. Thank you, Rob, for sitting down with me.
01:05 Rob Paczkowski: Sure thing. I'd say "expert," but I'm always learning. That's what's attracted me and kept me in the industry for thirty-four years, there's always something new, something interesting, an opportunity to learn and get better. So I've been at this a while, but I'm still learning as I go.
01:25 Eddie Chin: For sure, all of us. So what I want to talk about primarily is a belief you and I share: the experience someone has with their healthcare journey is just as impactful on utilization as any other factor. One key to driving great healthcare outcomes at a reasonable cost is for employers to embrace the balance of experience with other features. Tell us more about your take on it.
01:57 Rob Paczkowski: Absolutely. Experience is so important, it's the hook that engages employees and their families, especially that upfront experience. If it's really good, it hooks you in, and people are delighted. They come back for more, they tell their coworkers how great it was. But experience is also one piece of the overall puzzle, health outcomes and total cost of care are the other two factors that need to be balanced.
I also think there's a difference between measuring a great experience and just measuring happiness. A common metric is Net Promoter Score, or NPS. Both have their place, but we're talking about measuring good customer service, "I got my claims paid," or "I was able to engage with a Handpicked Health professional to find a great doctor." NPS is good and totally fine for that. But it's also good to know why people were happy or not. A score can give direction, but it doesn't tell you the quality, or lack of quality, of the experience. Having open text where someone says "tell me about that experience," and using AI to analyze those comments easily, helps us as employers, and helps you as partners, take action on the feedback.
But if we're talking about an actual encounter with a doctor or a hospital system, asking a patient if they're happy, or using NPS, is probably less helpful, because sometimes difficult information has to be shared during those encounters, and you don't want to sugarcoat it. You want the person to really understand the risk factors. So it's important to contextualize the feedback and data from patients.
When I talk about experience, I think of things like: would the member say they were treated with respect and had shared decision-making when they engaged with a doctor? It doesn't have to be "I'm so happy and loved everything." It's: did they treat me with respect? Did they engage in shared decision-making? Did we hit those key experience marks? Getting timely appointments is another big one, did patients feel they could get an appointment within the timeframe that met their expectations? That's an example of a great experience, separate from NPS or "would I recommend this." It's an important data point, because it tells us: okay, during that encounter they were happy with the shared decision-making and how they were treated, but they couldn't get a timely appointment. That gives us, as benefits practitioners, and you as partners, something to act on, how do we make that appointment process better?
05:14 Eddie Chin: And it goes beyond NPS, it's the whole experience from start to finish across the healthcare journey, from "I need to see a doctor" to the issue being remedied and all the way through. A lot of people just ask "what's the NPS score," and that's really just the opening bit of viewing the experience. So there's a whole lot of behavioral factors in play that have to be balanced with saving costs. How do you think about making that right call?
05:52 Rob Paczkowski: Driving a good experience requires some upfront investment, whether that's working with aligned partners like Handpicked Health, or other services like primary care. In the short term it may feel like a cost increase, but over the medium and long term it pays off in better health outcomes and lower costs. If people can get an appointment when they need it, they probably don't end up in the emergency room, and they probably don't get worse.
As you invest in the experience, there are things I'd consider costs, and things I'd consider investments. I consider a great experience, particularly around primary care and finding great doctors, an investment. There's a difference: when you make an investment, you're looking for a payoff over the medium and long term that improves things overall.
06:57 Eddie Chin: Right, knowing your desired end result and investing appropriately to get there. So where have you seen this work? Where have you seen members gravitating toward a better experience while also driving cost savings?
07:23 Rob Paczkowski: Two areas. One is using great primary care, which you all help employees find, those great docs who are out there but hard to find sometimes. In the primary care space I've managed over time, we've seen lower costs and better outcomes when employees simply had a primary care doctor. I'm not even talking yet about "advanced primary care", the next level, high-octane, person-centered primary care we'll get to. In studies we participated in over the last several years, employees simply having a primary care doctor made the difference. Across nine disease states, cardiovascular disease, diabetes, severe depression, for example, those who had a primary care doctor were, risk-adjusted, thirty-one percent less expensive than those without one. Risk adjustment means controlling for severity of disease, age, disease state, and other confounding factors. So simply having any primary care doctor made people thirty-one percent less expensive on a risk-adjusted basis. That's massive for our healthcare system.
The other area was subclinical coaching. In the past, we worked with good vendors who, when a patient came in needing care, administered a short questionnaire, the PHQ-9 (Patient Health Questionnaire, nine questions) or the GAD-7 (General Anxiety Disorder survey, seven questions). Based on the answers, patients were put into risk buckets: low, medium, or high. We discovered a lot of people fell into the low-risk category, but were going straight to a clinical psychologist for mental well-being care, when the reality was they weren't clinically depressed or anxious, just dealing with stress. They needed a stress management coach more than a clinical psychologist.
So, just like benefits practitioners have defaulted people into 401(k) contributions for decades to remove friction and get people started, we did the same here. Anyone in the low-risk strata was defaulted into talking with a stress coach instead of going straight to a clinical psychologist, and clinical psychologists are about twenty-five percent more expensive than stress coaches in our data. Once we started defaulting people in, utilization of subclinical stress coaching went from about two percent to twenty-two percent. As utilization shifted to the more efficient care setting, costs came down twenty-five percent. It doesn't have to be either/or, with good behavioral science, you can get people into the right care settings, improve health outcomes, improve the experience, and bring down costs at the same time. We as benefits practitioners and partners have to be looking for those opportunities, that's where the value is. If we can take costs out of the system by getting people to the more appropriate care, rather than raising deductibles or copays or premiums, we can save money and improve the experience at once.
12:07 Eddie Chin: It's almost like there's a myriad of solutions out there, and it's hard to know which one is right, so you end up defaulting to what you know, in your example, a psychologist rather than a coach. But by investigating what's appropriate, you end up choosing the coach, a better solution, a better experience, and cost savings all at once.
12:40 Rob Paczkowski: Totally. You remove friction by setting the right default. In our case, people weren't required to go to a subclinical coach, they could still choose a clinical psychologist, and some did. But by removing that friction layer, we're saying: we know something about you from this questionnaire, so we're going to default you into what we think is the appropriate medium. You can always opt out, just like a 401(k) default of four percent to maximize the match. Some people are fine with the default; others opt out. Using information to help people make good choices reduces decision fatigue, but you always give them the opportunity to opt out and change.
13:42 Eddie Chin: So where does guidance fit into that, the concept of care navigation, understanding your options, finding the best solution for your journey?
13:55 Rob Paczkowski: It's incredibly important, because standard tools these days, no knock on our partners at the medical insurance carriers, don't give you a whole lot. They might tell you who's in your zip code, but not how to actually find a really good physician, facility, primary care doctor, or specialist for your specific needs. How do you know they have appointments available? How do you know they still take your insurance and haven't dropped out three months ago while the carrier's directory wasn't updated? How do you know they actually specialize in what matters to you? Those things are largely invisible in healthcare today.
That's where partners like you come in, with a large data set showing which physicians and specialists have the best appropriateness and clinical quality scores, combined with white-glove understanding of the patient's needs, appointment expectations, and insurance, to find a great-fit doctor and schedule the appointment. Navigation is about removing that friction from employees, because we want them focused on the next big thing for our companies, not sitting on hold trying to find out if a doctor takes their insurance or has appointments.
15:56 Eddie Chin: Helping people figure out their next best step in the healthcare journey, paired with what you mentioned about PCPs, really gives you that one-two punch. Say more about advanced primary care and its impact.
16:15 Rob Paczkowski: That's the next level, shifting from the current state, which sort of functions, to a more person-centered primary care experience. An independent physician, not tied to a big hospital system that steers you only to providers inside that system, doing person-centered care, not paid on CPT billing codes, and only incentivized to provide great care and be your quarterback for all your care, not required, but something people want to do. A quarterback who knows everything about you and can coordinate your care across specialists, primary care, and lifestyle changes. That's the difference between advanced primary care and what I'd call basic, baseline primary care.
17:31 Eddie Chin: So a care navigator to help you figure out where to go next, and an APC as the quarterback for your healthcare, combined, that gives you a healthcare experience people actually want to use. You mentioned thirty-one percent savings from PCPs being the front line, and twenty-five percent from finding the right solution in the coaching example. That's pretty significant.
18:01 Rob Paczkowski: Absolutely, and it improves quality too. Really good quality actually costs a lot less, because if you're getting things right the first time and not redoing work, that's always less expensive. The thirty-one percent risk-adjusted savings from any old primary care is significant, but with advanced primary care, truly person-centered care, integrated behavioral health, integrated physical medicine, integrated prevention, I'd guess it's even higher. The sky's the limit.
18:44 Eddie Chin: What do you hear from employees about their challenges, going through long lists of doctors to find the right one, and other challenges they face?
19:17 Rob Paczkowski: Under the current carrier model, employees get a list of docs, call several, and find some aren't taking their insurance anymore, or don't have appointments within any reasonable timeframe, sometimes a year or two out. Not helpful. So they spend a bunch of time figuring out who's in-network and has appointments, before even getting to who's the best fit or highest quality, that's mostly absent from the equation.
Employees are thirsty for this kind of information, but the challenge is that people don't always know what "good" could even look like in this space. They're so used to the status quo being broken that they throw their hands up. So part of our job is storytelling, showing them how it should function and introducing a new service that can get them there, because they've been disillusioned by how everything works today.
20:40 Eddie Chin: There's also a story around the anxiety of looking for a provider, you may have an emergency, you don't know if it's an emergency, and you're trying to navigate that while also facing a long wait for an appointment. That's really frustrating for people.
21:08 Rob Paczkowski: Totally, and then people default to what they know: the emergency room, or a local urgent care clinic that knows nothing about them. Most companies these days are tasking us to use AI tools to make benefits programs come to life better, and I think there's a huge opportunity there. We've built GPT and Slack integrations trained to crawl our content and our partners' content, so people can ask simple natural-language questions and get succinct answers.
If someone has a kid with a suspected ear infection and asks what to do, instead of defaulting to the emergency room or urgent care, where you might catch something else while you're there, or your healthy kid gets sick too, we can direct them to a great telemedicine program, often free, where a doctor can assess the situation over video and write a prescription within fifteen minutes. I talk to employees all the time who say, "I didn't realize we had that." So bringing these AI tools to the forefront and making them easy to access on their phone, so employees actually understand the ecosystem of support their employer provides in a time of need, I think that's something we've had good success with, and it's a massive opportunity for the industry.
23:41 Eddie Chin: I love that interaction, benefits leaders guiding employees, being their advocate within the organization. That support is so critical. You also mentioned making sure employees actually use these tools, which means we need better relationships with our benefits providers and leaders, and a better understanding of what's available to keep us healthy.
24:28 Rob Paczkowski: The tools help that scale. I can have one-on-one conversations with employees in the hallway, but when someone's at home on a Sunday at seven p.m. with a need, I want them to know what tool to go to when I'm not there. So part of it has been trying to clone myself into these tools, what would I say if I were talking one-on-one with an employee about a health concern, and building that into the AI tools' content, so that on Sunday night when you have a sick child and ask a question, you get that same experience, with clarifying questions like "are you experiencing chest pain?", things that would mean you should go to the hospital. But "I have a pain in my ear" or "my son has an earache" can be triaged toward a zero-cost, high-quality telemedicine encounter, or toward your primary care provider's online portal if you have one.
That's maybe a differentiator between advanced and regular primary care too, regular primary care is open eight to five, and we all know we and our family members rarely get sick between eight and five; it's usually evenings, weekends, one in the morning. Advanced primary care aims to give you that twenty-four-seven access. Without it, you end up in a bad situation, probably an ER visit you didn't need. So having tools that feel like part of people's lives, accessible on their phone or via chat, is the ideal.
26:47 Eddie Chin: You mentioned virtual APCs, how do you feel about how virtual APCs are going, and how they can be helpful in this model?
27:02 Rob Paczkowski: I think the majority of primary care encounters can be done virtually, not everything, but a lot. It's mostly a cognitive encounter: you're talking about signs or symptoms, and the doctor is talking back to you. There may be labs or other things, but it's cognitive-heavy, so most of it works virtually.
What we're very interested in is how a human touch is handled within virtual-first primary care and APC solutions. For example, a diabetic foot exam, is it just a referral with no connection back to primary care, leaving it up to the patient to bring the results back? Not a great experience. So we test for whether there's a robust process to share results back with the original primary care doctor, not just with the patient, requiring them to do the legwork, so it actually feels like coordinated care rather than an offhand referral. Virtual care can handle more than ninety percent of primary care needs, but it's essential that labs and physical exams have a solid mechanism to share data back for true coordination.
28:58 Eddie Chin: Multiple avenues of care, all coordinated, not fragmented. We could talk about this for a long time, but we're running out of time, one last question. What should employers, employees, vendors, and providers be thinking about when we're done with this conversation?
29:26 Rob Paczkowski: A lot of it comes back to telling the story and helping people understand these models, because a lot of this is new, advanced primary care isn't just a new term, it's a new concept. People would be amazed that models exist that are one hundred percent centered on the patient, with no incentive other than to make you better, get you appointments when you need them, and treat you with respect and shared decision-making. I think the key is continuing to tell that story and educate people that something better than the status quo exists, because changing human behavior is slow, and we can't underestimate either the storytelling or the time it takes.
30:38 Eddie Chin: Human-centric care, who would have thought? Having virtual or in-person care navigation and care centered around you, all in one place.
30:54 Rob Paczkowski: It's rare, that's the thing. People would be delighted to hear it, but they'd be surprised.
31:05 Eddie Chin: I think so, but there are organizations working on it, and I'm glad that's happening.
31:14 Rob Paczkowski: Absolutely. As we talk about saving money, the easy ways are raising copays, deductibles, and premiums, but there's only so much you can do with that. You have to understand the underlying causes and address those, both with solutions and with public policy advocacy, because there are a lot of misaligned incentives in our current system. Working on Capitol Hill on policies that improve the underlying ecosystem, so we're not continuing to ingest poor policy, but positive policy that makes it easier to do what's right for patients, is another opportunity. I'd challenge benefits practitioners to get more organized around this, through policy circles and trade groups we belong to, like the Purchaser Business Group on Health or the American Benefits Council. We're the non-conflicted, honest brokers in the room on these things, and we could have a big influence if we used our voice more collectively.
32:47 Eddie Chin: Public policy is such a critical piece of this. What policies are you tracking that other employers should be looking at?
32:57 Rob Paczkowski: A few examples, some past wins, some current. About seven or eight years ago, the Cadillac tax was on everybody's mind, a significant excise tax increase on employer-sponsored healthcare. Employers and trade groups organized and ultimately defeated it, which was well-intentioned but not great policy, and it saved millions of dollars per employer every year, just for offering a good plan, not gold- or platinum-plated, just a good plan.
More recently: transparency. Prices and quality are hard to find, there's a lot of opacity in the market. Some transparency regulations are now being codified into legislation, which is a good start but needs a lot more work. Also, the "One Big Beautiful Bill" passed last year included good provisions making advanced primary care easier for employers to deploy, particularly those with health savings account arrangements, reduced friction there.
There's also interest in reforming the RUC, the Relative Value Committee of the American Medical Association, which recommends what percentage of Medicare different services should cost, for primary care versus specialty care. Reforming that could help elevate primary care, which has been at the bottom of the barrel. And on the pharmacy benefit manager front, mostly positive developments: required disclosures from PBMs and medical carriers of their direct and indirect compensation, so employer sponsors know exactly what they're buying and how much they're paying, the way you'd expect to know a television costs five hundred dollars, which isn't yet the reality of how we buy healthcare services. We need to understand total cost across all components, along with quality, particularly of doctors. Those are a few examples.
36:02 Eddie Chin: You mentioned the Purchaser Business Group on Health, PBGH. How can they help employers keep up with these changes and figure out the best policies?
36:18 Rob Paczkowski: They do a great job. Full disclosure, I'm on the board of PBGH and co-chair of their Public Policy leadership group. What they really do is bring together the collective voice of purchasers interested in driving better public policy. They have partners on the Hill influencing policy, taking our feedback, and communicating it to policymakers day to day. They even bring us to the Hill from time to time to tell our stories about what's working and what's not. They're a great organization for bringing our voices together, but we need more employers to step up and be part of the solution on the policy side with organizations like PBGH.
37:17 Eddie Chin: That's all awesome, Rob. Thank you so much for your guidance, your time, and your generosity in talking to me today. I hope we get to do it again in the future.
37:35 Rob Paczkowski: Sounds great, I appreciate it, Eddie. It was a pleasure, I love working with you and the Handpicked team. Let's do it again soon.
37:44 Eddie Chin: Awesome, thank you again. And thanks to everyone who took the time to listen or read the transcript. We'll look to do this again, we're going to post this version too, hopefully.
37:58 Rob Paczkowski: Sounds good.
