Building The Noise with Jeffrey Lewis: EPISODE 010

SPEAKER_01 0:00

I go talk to a local school. I meet the teachers. Here's what we do, here's how we do this, give them my pitch. And we have this $2 drug program. About a week later, the phone rings. Here's a teacher. I'm taking a Crohn's disease medication and this probiotic, and I'm paying about $5.75 a month. And I really can't afford it. I said, tell me what the name of your drug is. I called a pharmacy owner and I said, okay, so can we do this? Well, we can. Here's what's going to cost. And I said, add it to the formula. She calls me 30 days later. I can't believe it. I went to tell her pharmacy. I paid $2 for my Crohn's disease. You've just saved my family $500.

SPEAKER_02 0:41

Welcome to the Building the Noise Podcast.

SPEAKER_00 0:44

Ladies and gentlemen, welcome to another episode of Building the Noise. Today we have a fantastic philanthropist and truly an advocate's advocate. I know I said that about Brandon Maxada, but Jeff who was introduced to me by Brandon, I think outdoes Brandon. And that's for Brandon to figure out. Jeffrey Lewis is the president and CEO of Legacy Health Endowment. His background spans many years in public service, health policy, and truly venture-driven philanthropy. The simplest way I can put it is an issue that needs to be addressed, and everyone else wants to put their uh head in the sand. Jeff attack. Jeffrey, thank you for joining. There you go.

SPEAKER_01 1:35

Yeah, it's great to be with you, and look, I will be 72 next month. You look fantastic, my friend. You think I look like I'm younger? Yes. And uh my goal is to do this job for another four years and then uh in the meantime find uh whoever might replace me.

SPEAKER_00 1:57

Sure.

SPEAKER_01 1:58

But living in rural California and having done this for ten years was the best decision uh I ever made. The community has been a petri a healthcare petri dish. We've done and continue to do some unusual and exciting things that most philanthropies, I'd say 98%, don't do. We get our hands very dirty, we dig into the dirt. Uh, we want to know the why. And we have a lot of conversations with people across communities. And if it's in Spanish, I take one of my staff with me to interpret, and you understand the why. So I'm always, I want to know what the why is. And then you from the why you can figure out hopefully the how. And you build the pieces. We're builders. Uh, and as I say, I've learned over the last 10 years the art of building uh and the art of delegating. But you know, I'm really lucky. I've got five staff members who are team members, three of whom are fluent in Spanish, all women, phenomenal human beings, each individually and collectively.

SPEAKER_00 3:09

Yeah.

SPEAKER_01 3:10

So, you know, for a guy my age and having done this and having it being encircled by that kind of brain thrust, it's a blessing.

SPEAKER_00 3:18

That's fantastic. What stuck out to me about the work that you are doing in our initial conversation was just how creative you've been in your approach. And I've worked with a lot of disease state nonprofits that, to be frank, they're not that creative. Where does the creativity come from? Where does that drive come from to help your community, but help those that are often unseen by others?

SPEAKER_01 3:48

You know, the unseen population can be rich, it can be poor, it can be multiple colors, multiple ethnicities. And as long as you start from that premise and then you build from that. I mean the creativity comes from a lot of conversations. I always tell the story that I spend a lot of time in cigar bars.

SPEAKER_00 4:10

Good place to be?

SPEAKER_01 4:12

It's a great place for a married guide to hide to be safe. Uh when your wife lives two and a half hours away. There you go. But you often have a lot of conversations because people that come to cigar bars often just want to talk. And I like to listen. Well-trained lawyer. Um, and you listen to them and ask a bunch of questions. It gives me ideas for you know the poetry books that I write once or twice a year. But more importantly, I can ask questions to really understand the why. And I will always come back to that. Because the why gives you the ability to understand the complexity of a challenging problem, the complexity of people's lives, and then your ability to dissect that in a way that you can then create a potential solution. Because you have to understand that, you have to have the underbearings to really understand how to build up. It's easy to build down, but to understand how to build up, you really have to have ongoing conversations. I would say that we do 15 to 30 focus groups a year with people, conversations. We launch this big women's health initiative focusing on women 30, 18 to 60, with an emphasis on perimenopause and menopause. Anybody's uninsured or commercially insured, who often have either high deductible health plans or no health insurance. But helping them is one part. Educating their spouse or partner is an important second part. So last night we had 13 men for dinner with a with Dr. Katrina Sagosha, who's actually a brilliant physician specializing in perimenopause and menopause, and she talked to these guys. And they could ask any question, and which most of them did. There was no such thing as a stupid question, and allowed her to dive in and allowed them to dive in as well. To understand the why. But more importantly, it was the follow-up I went back and to everybody and said, Would you be interested in coming with your wife to have dinner with Dr. Tina? That's what I call her. Five immediately responded, I'm waiting to hear from the rest. But the fact that I could have dinner with Dr. Tina and her husband, Dr. Davin, who's an anesthesiologist, with these couples where they could really talk openly about perimenopause or menopause. And if they're not talking openly, they'll be questioned because not only from the Dr. Tina, but more importantly, using their first name. How do you deal with the night sweats when you know you wake up in a puddle of water and your wife is sound asleep? And what do you you know, what do you do about that? What's the conversation that you have? And more importantly, how open can you be or are you with each other? So it's healthcare, it's therapy, it's understanding, wanting to understand the why, but it's also introducing something that doesn't happen in rural communities to conversation about tough topics like perimenopause or menopause. We got into this because I'm encircled by not only the women in my office, but more importantly, a lot of women advisors, you know, who I seek their advice. What do you think about this? What do you think about that? Some consultants, others just free consultants. Perimenopause and menopause has come up consistent. There's just nothing out there. What are we going to do locally? And we began with a lunch. And while planning the lunch, I'm like, well, we can't just do perimenopause and menopause. Let's just broaden it. Let's do women's health and let's focus on the totality. But let's build a network of healthcare providers, only women. So I have four women physicians and one woman uh physician assistant. No male providers are allowed in the circle because I want you as a woman who's going through perimetopause to talk to another woman who's experienced it or experiencing it. And, you know, a male doctor can talk to you about what he ex his experience, what he knows from patients, what he read, etc., but he can't talk to you what it means in real life. And I'm about a real life guy. You know, I want you to be able to have that conversation so that you can get the best advice possible. So we're we just recruited another physician uh to help us who's an Alzheimer's dementia expert from the University of California, San Francisco, Dr. Carla Personado, who comes down here once a month to meet with Alzheimer's dementia patients and their families. So it's one thing to talk to a patient about his or her challenges. But if you're not talking to the family collectively, to understand the caregivers' challenges or the spouse's challenges or the child of an aging parent's challenges, you're really missing out on the other pieces of the puzzle. Healthcare is a puzzle. We're never going to have all the pieces. And the creativity from our side comes from really wanting to understand how do we build a puzzle that stays together.

SPEAKER_00 9:42

I think what I've seen from industry, for example, is a desire to discuss the semantics. For example, is it care person, care partner, care giver, rather than addressing their voice and making sure that they understand they have one. How do you get over that?

SPEAKER_01 10:06

Attack it. You know, you solve a problem by first attacking a problem, not being afraid to use your voice. I'm well published in the local Tour Light Journal, probably overpublished, and they're very gracious about accepting pieces. Um we talk about a lot of issues, mostly healthcare. But if you don't use your position to raise the issue and the conversation, and have that conversation, whether it's with five people or 50 people, you're really missing out on a learning exercise. Books are great. YouTube and every internet social media site, they're wonderful. What's really great is having a conversation like this. We may come up with, you know, you're going to see me writing things down that you're saying that I think are absolutely brilliant. You know, like adventure-driven philanthropy. That's a great term. It's not, you know, it's it's different. And it's really, it is an adventure. I mean, it's really, all right, how do we do this in a way that's really going to be fun? At the end of the day, it has to be fun and learning. And sometimes the learning is exhausting because it's not going in the direction that you want. So you either pivot or you accept the direction that you're going and use it as an unabashed learning exercise to figure out the why.

SPEAKER_00 11:33

And I I think you said it so well, though, with regards to being willing to listen, but but knowing that you have to go back to that community and continue to show up. You made the opportunity available, but now you know, and you thought about all of the components about what will build trust in those guests that are coming, what should that look like, what should the makeup be, as you talked about with regards to the women that are coming to hear from a physician, making sure it's a female physician. Right? Because the optics just look completely wrong when it's not.

SPEAKER_01 12:11

You know, and giving women the ability and the opportunity to grow. So out of this, uh, a young woman, I mean young compared to me, in her 30s, wanted to go back and was so inspired to become a nurse. Well, we have a nursing scholarship program, so she can go for free. Wow. And her payback is, you know, taking care of patients in our by-county area for two years and while she's working, that's her payback.

SPEAKER_00 12:40

That's fantastic.

SPEAKER_01 12:42

It is amazing. And I want to keep coming back to the question you raised about creativity. And you know, creativity is the ability and the willingness to listen. That's really what it means to me. Even when you don't want to hear it, you really want to listen to it. Because every opportunity is a new learning exercise. There'll be things we will completely disagree with. But you know, that that listening opportunity, often rare, is an invaluable investment of time.

SPEAKER_00 13:13

Yep. And what I'm hearing though, it's also being willing to show up and listen without an agenda.

SPEAKER_01 13:21

Right.

SPEAKER_00 13:22

You're not trying to shape or move the community in any way. You're trying to understand where the community is first.

SPEAKER_01 13:29

It is. And also, you know, you're going to give someone the best advice possible. And at the end of the day, you're an adult. I can't, you know, I can't make you do something, but I can tell you the here are the pros and the cons, and here are the consequences of action versus inaction. And then you're going to make a decision. You know, it's like it's trying to say to somebody who's wealthy, I could take your Social Security check for a year. So let's say getting $5,000 a month, um, and I could go out and with a bunch of those same checks uh target older women over 80 who are struggling just above Medicaid and just trying to make ends meet, but really struggling. I can go out and buy an annuity using their dollars and turn them and give them a charitable deduction because it's a creative way of helping somebody else. You know, you you think about it as if I'm not helping, I'm not really a helper.

SPEAKER_00 14:26

Yes.

SPEAKER_01 14:27

And if I'm not listening, I'm not really learning.

SPEAKER_00 14:33

We're all meant to serve.

SPEAKER_01 14:35

Uh I that's what it that's really what it's about because it makes us not just servants, but it gives us the ability to really smile. You you can see how somebody's being helped. You don't have to be there. And you never forget the smile.

SPEAKER_00 14:54

That's fantastic. I guess I want to go back to the beginning. Why did you start doing this work? Why the pivot from politics into the nonprofit world?

SPEAKER_01 15:07

Um, I was working for U.S. Senator John Hines. Uh, you wake up on April 4th in the morning, you take a train to Philadelphia to do a field hearing the following day. Uh at noon, you get a call from the chief of staff saying, and I was the Republican staff director for a committee. Uh his chief of staff says there's been an accident. Uh ultimately the airplane was an airplane crash, and the senator was killed. At some point over the next eight weeks, I had a conversation with his widow uh who wanted me to come work for her, and I didn't really know what I wanted to do and ultimately accepted the opportunity. Spent 20 years working with Theresa Hines and had a phenomenal experience for 20 years and worked as her chief of staff and also ran her personal foundation. I got into it that way. So I learned through her eyes a variety of things that you never forget. You know, life's lessons on things that you take with you. And then from that I went back to the corporate world and consulting, and one day, literally, I was on a computer helping a friend look for a job, and this is how it happens. A job pops up, you know, philanthropy in Turlock, California. My wife had gone to school at Mills College in Oakland, and I said, You ever hear of Turlock? And there wasn't, I'm sorry, where? Anyways, I sent a resume in because my wife wanted to go west. She wanted to leave D.C. She had had enough. And one thing turned into another, and we interviewed, uh, I interviewed on a Skype call. I remember it well because the first question from the board meant one board member before they asked anything else was how long I had been bald. And yeah, and he was bald, or he was a baldine. And so I his name was uh Bill Gibbs, phenomenal, great man. And I said to Bill, Well, I think ever since I can remember, and uh didn't really tell him the whole story. And then I said to him, but I'm now gonna make you a member of Bob. And you're like, What's Bob? I said, now you're a brother of Baldus. That's how the interview started, and then for the next hour they peppered me with questions, and ultimately I uh we worked out it worked out. I ended up out here, we we ended up out here, and the rest is history. We've been doing this for now for 10 years.

SPEAKER_00 17:38

So why the pivot to philanthropy? What what is it about philanthropy that for many people they hear you know fundraising or trying to figure out what to do with that money and run? But for you, it was an opportunity.

SPEAKER_01 17:56

It's it's creativity that if you don't grab on to, you miss a part of your life. So it's the part of philanthropy is I don't have to raise money. We have two endowments, we have two different philanthropies. So combined, you know, we have a significant, well, significant in my world, but $105 million combined endowment.

SPEAKER_00 18:19

Yeah.

SPEAKER_01 18:20

We use those to create or fund healthcare solutions, broadly defined. And not having to have to go out and raise money to challenging other nonprofits allows us the ability to really think about the challenges you're facing. California is a petri dish of multiple challenges. You have a huge undocumented population that's going to lose many, multiple healthcare services. You have a growing middle class population that have or pay high deductible health plans because it's the cheaper premium that they can find for a $5,000 or $10,000 deductible. You have uh families that will pay for uh 100% for their children's care and ignore their own health care. So you figure out creatively how am I gonna take care of mom and dad? How am I gonna take care of their parents? We have an aging population that's aging in place, uh, with their biggest asset maybe being in their house. Sure. Yeah, Social Security is gonna be their backbench that's they're gonna depend on. They might have a 401k, they don't have a defined benefit plan, they don't exist anymore unless they were in the public sector. And there's nothing from the federal or state or local governments that's gonna help them. So we've been successful in working with the city of Torlock, a phenomenal mayor and city council, where we took ARPA funds and created a community-based long-term care program where people who need a respite care can get 20 to 30 hours a month at no cost. And matching that with charitable dollars to expand those services. Partnering with sharecare.com, I think the best respite care company in America, uh, delivered services that people just uh are delighted about. We pivot from that to mobile home parks, which there are many across our by-county area, and where multiple senior citizens live in these mobile home parks, typically lower income or lower middle income, but living on edge, where if they raise the rent, let's say $50 a month, that's $50 less for food or medication. So we just launched a new mobile home park program with Covenant Care Home and Hospice, our local community hospice that is unique and phenomenal administrator, where we're serving mobile home park residents. We started in one with a series of home care services, as well as a meal program, uh fresh food, uh Monday through Friday from a local school system, Daenerys Unified, where they make 90% of their food fresh every day. Uh they get food delivered to them and we stack up on Friday to make sure they get through the weekend. And we're moving from there to another no-mobile home park to another, etc. And the goal is to find out you know, how are these set of services enhancing or protecting the lives of these retirees who vary have varying incomes.

SPEAKER_00 21:26

Yep.

SPEAKER_01 21:27

Uh, and and we then buttress that with a program called Bridge to Home that we've worked with Covenant Care at Home and Hospice to create. If they're hospitalized and they live alone, they will be picked up, taken home. All the if they can't afford their meds, the meds will be bought for them. And for the next 48 hours before they qualify for Medicare Home Health, they have a series of services. The re-entry rate to a hospital is 7%. What's the national rating probably?

SPEAKER_02 21:57

Wow.

SPEAKER_01 21:58

17%. So is the program work? Yes. Uh can it be replicated? Easily.

SPEAKER_00 22:05

That was gonna be my question.

SPEAKER_01 22:06

If you're curious. We are we operate open source. So everything we do, we want you to know about and to be able to replicate.

SPEAKER_00 22:17

See, this is where most folks would typically go, which is that, well, that's in two counties in California. It's different. It's not gonna it wouldn't work here. It wouldn't work in Illinois or it wouldn't work in New Jersey. But you're open sourcing it and you're showing people how it works.

SPEAKER_01 22:34

It gets even better. So I'll do a Zoom call like this, and I'll say, okay, I'll consult for you on the project. No cost. I don't Wow. You pay for my airfare and my hotel and food, and I'll come out and spend a day or a week, whatever you need, to help you build this solution. And if that means talking to your donors about it, if you have donors or your board about it, I'll do that as well. But I don't want any I don't want any money. I'm just gonna cover the expenses for the foundation.

SPEAKER_00 23:03

That's fantastic.

SPEAKER_01 23:04

And you give them an opportunity. Do the people who want the opportunity? Well, that's a whole different story. Are they really that curious?

SPEAKER_00 23:11

Yeah.

SPEAKER_01 23:12

Um it's it's hard because when you're in a as small as we are in $100 million doesn't sound small, but in a world of philanthropy, it's small.

unknown 23:22

Yeah.

SPEAKER_01 23:23

When you're in rural California, it's even smaller. Um so you know, you just go out every day, you wake up and say, okay, what's the challenge today? And how do I how do I help?

SPEAKER_00 23:37

Yeah.

SPEAKER_01 23:38

I wake up thinking, also, there's a my my favorite restaurant in town is called Footers. Forty different kinds of hot dogs you can get in downtown Trelock. The best restaurant, because I've never had a hot dog in 10 years. I get a salad typically. But they started making soup. The guy makes great soup. So, you know, I think about, oh, I'm gonna call Michael. What's the soup of the day? And um, but you know, when you you think about this, and then what's the Nux big problem? Diabetes. You know, it's attacking Hispanic children, um, Hispanic adults, um, all adults. So what can you do? So we partnered with a local clinic created by three physician assistants called the Kind Clinic. Um, uh Alicia Conway, Louis Micardo, Edgar Makardo, uh, three amazing physician assistants dedicated to the community to serve. So I sat down with them one day and said, you know, we have this huge diabetic problem. Why don't we launch a diabetes program where they come to you and services will be free. I don't care if they have insurance or no insurance, but it's 100% free. Get them in the door. You do the analysis, you do the blood draws, we see what their AONC is, and then we build a program to challenge them.

unknown 25:05

Sure.

SPEAKER_01 25:06

Are they really committed? And let's do it with Lily on the Munjaro side, where we're paying for the Munjaro, because I'm a big believer in Munjaro, and we'll talk about it endlessly to anybody who'll listen, because I'm a type 2 diabetic who's been on Munjaro, and it's been a phenomenal program. That's good.

SPEAKER_00 25:23

I was almost a type 2 diabetic. Thanks to Mujaro.

SPEAKER_01 25:27

Yeah, all good for you. And my A1C is today at 5.6, so I'm you know doing good, but I'm still on it. Um, and we built a program to help people who had type 2 diabetes, and we saw, you know, change. Now, some people dropped out because they did it for weight loss and bailed. But my favorite will always be the gentleman who's a Semitic gentleman working in Turlock, overweight, never dealing with his diabetes, wife petrified about this, daughter who I got to know quite well. And we got him on the program. And today he's the poster child for why we did this program. A1C is way down. Weight is way down. He's learning to eat better, he's making sure he's drinking water, he's making sure he's not having you know too much soda, like some of us. And you know, he ignores the diet coke, where I don't, and he's taking care of himself. And so when you think about why this, it's that smile. Or it's it's the guy named Eddie Pimentel, who is this wonderful person who's a taco truck guy, who has three or four taco trucks, and who will literally give you the shirt off his back. And he starts talking about healthcare to me, and I talk about, well, tell me about your family. And I learn about his family, about his wife, about kids, about the nephew. Take him to the Kine Clinic. You need they need go see the Kine Clinic, go see Alicia, go see Louise. And it's free. And he looks at me like, what do you mean it's free? I said, Yeah, it's not about insurance, you're not on Medicaid anyway. Just go in there. And they get them taken care of. And we and you know, when you can say to a family, go here, go there, okay, I want you to go, I want you to go see so-and-so. Um, you're helping them out. Uh and we build programs for people with cancer. You know, biggest challenge facing not just not just cancer when you have it, but how do you pay the bill?

SPEAKER_00 27:40

Yeah.

SPEAKER_01 27:41

We had a young woman who passed away from stage four cervical cancer who uh is absolute tragedy. And beautiful. Her picture with her mother and brother sit on my desk with me with the four of us. And I look at it all day, every day. And I think about Britain every day. But I think about the families that we can help who've got debt from cancer.

SPEAKER_00 28:01

Yeah.

SPEAKER_01 28:02

And you start working with local hospitals hoping that they'll connect with the people by saying, okay, you always say $10,000, but there's this program if you want to connect with them. And you just keep thinking about different ways that you can reach into somebody's life and touch them to help them with something small or medium or large that they can carry forward.

SPEAKER_00 28:25

Sure. See, and that that sense of curiosity that you discussed, that that real curiosity that you carry with you every day. It sounds like you are the mayor yourself of Turlock, um, and probably could be. No. No.

SPEAKER_01 28:42

The mayor of Turlock does a great job. City Council does a great job. And uh I made my wife a promise when she agreed to move from Portland, Oregon back to DC that I would never run for office. And she's always reminded me of that. I'll forever be guy on the sidelines.

SPEAKER_00 29:01

See, but but that that real curiosity, though, is what helps carry it forward. Because you've heard their story, you understand their plight, and now you can't stop.

unknown 29:13

No.

SPEAKER_00 29:13

I feel like I mean, you look at hospitals and you look at the industry, pharma, biotech, anybody, and they're you're missing that curiosity. The the hospital used to be the center of the community. Back as far as I can in the nineties. It kind of ceased after 2000. But you used to hear the CEO of the local hospital and the local radio stations talking about this community event and come on out and make sure your lights don't get turned off and all those sorts of things. But nobody seems to be doing that work about thinking, as you've referenced, thinking about the patient as a full human.

SPEAKER_01 29:55

You know, local hospitals do those kinds of things to some degree. But you can't depend on them anymore. You have to figure out ways to bring that service right to somebody's home. You know, when I talked about Dr. Carla Personado, our Alzheimer's dementia expert, she's going to patient's home to talk to them about Alzheimer's and to treat them there. Not uh not worrying about seeing them in an office. You know, she's that really rare doctor that wants to make it as easy for the patient and their family as possible.

SPEAKER_02 30:32

Yeah.

SPEAKER_01 30:33

And the same thing with our neurology program that we have with UCL, University of California, San Francisco Department of Neurology, where you have visiting neurologists every two weeks into a neighboring town in a more rural community. Uh, they're packed for the next six months because you can't find a neurologist here for it takes you anywhere from five to nine months to get an appointment. Wow, wow. So the whole idea is how you can plug and play. And now we're working with a local FQHC to make it a specialty clinic, to bring in a pulmonologist, to bring in a radio uh urologist, etc., and give people greater access of all incomes, never ignoring a Medicaid population or in California, a Medi-Cal population, but also never ignoring a middle income population. My goal is ultimately to create a women's health clinic that we would have in Turlock that every woman could go to because she would walk in the door, present whatever insurance card or not, and then she'd be given an ID. Insurance cards would never, so everybody's equal. Same, everybody has the same ID. You know, whatever color it is, and it says the Turlock Women's Health Clinic. And you lower the plate form, you make it easy, and then make the bar lower, but more importantly, you treat everybody equally. It doesn't mean they can speak English or Spanish or Farsi. This community is an international belting pot. You have Iranian, Iraqi, Portuguese, Swedish, Hmong, Punjabi, Sikh, African American, white. Um you have just multiple cultures really blending together, uh, in many cases, in some cases not, but all of which need services, and you've got to figure out how do I do it with each one, or how can I blend them together and how do I do that?

unknown 32:30

Yeah.

SPEAKER_00 32:31

It's an enormous challenge. I bet one of the things I was fascinated with was the pharmacy you created.

SPEAKER_02 32:38

Yeah.

SPEAKER_00 32:39

Tell our audience a little bit about that. I mean, people hear about pharmacies and they get worried about what money are you taking out of my pocket. Um this is unheard of.

SPEAKER_01 32:50

So we have a local pharmacy, Tower Pharmacy, that we partnered with. It's a privately held uh independent pharmacy, which are very few in America these days. Phenomenal owner, young man. So I went to him one day and said, I want to start a $2 prescription drug program. And he kind of looks at me like, well, why two dollars? I said, Well, years ago, we had a $4 program that Walmart did, and I did that with the Corey Booker when he was mayor of Newark, New Jersey. We had two private pharmacies there. We did the same. Well, we did it in Newark and these two pharmacies, uh, one owned by a guy named Rich Mysticelli, if Rich is ever listening. I want to give him a shout-out. Uh happy, great partner. So I carried it forward to Turlock and said, Well, four bucks is too much. I want to do it for two dollars. So we built a list of a thousand different generics. Um and then as people started using it, and the pharmacy would call and say, Well, they need embroil. Well, what's the cost of this? They don't have insurance. Uh it's going to cost X. Okay, we'll give it to them. Sometimes you try and set them up with a patient assistance program or a copay program, and the car and the pharma company should be thanked for those. They work if you know how to work the system. Yep. Um, but they get they get their embroil for two bucks. And then we pay the difference in whatever the copay is, at least for 30 days, to get them started. And now every HRT drug that women need in our community are $2 except for testosterone. It's not on the formulary, which includes all the patches, so they're now paying less. But here's why. I go talk to a local uh school. I meet the teachers, here's what we do, here's how we do this, give them my pitch. And we have this $2 drug program. Yeah, yeah, yeah. About a week later, the phone rings. Here's a teacher. I'm taking a Crohn's disease medication and this probiotic, and I'm paying about $575 a month. $575 a month. And I really can't afford it. And it's just covered by your program. I said, you know what, I'm not sure. Tell me what the name of your drug is, and she gave me the name, what's your dosage. I called the pharmacy owner, and I said, okay, so can we do this? Well, we can, here's what's it going to cost? And I said, add it to the formula. She calls me 30 days later. I can't believe I went to tell her pharmacy, I paid $2 for my Crohn's disease. You've just saved my family $500.

SPEAKER_02 35:25

Yeah.

SPEAKER_01 35:26

And I said, Great. Now what she doesn't know is that for certain classes of drugs, I will then say to the pharmacist, I need to, because for HIPAA purposes, we protect them.

SPEAKER_00 35:36

Yeah.

SPEAKER_01 35:36

I don't know who they are, unless they call me. Um, I need to talk with this family. Will you ask them if they'll talk with me? Because I want to know what she's doing with the $500 a month or $6,000 a year that she's saving. What are you using the money for? Are you saving it? Is it paying for food and utilities? You know, are you able to save any of it? Or is it really just going out the door to other family needs because it tells a better story? Um and then, you know, if you were to say to me, are there any pharma companies partnering with you? I would gladly stand up and say, no, I would, I will partner with any pharma company that wants to partner with us to bring lower drug prices to anybody in these communities. Our work with Lily is Lily doesn't know we exist. But we're buying they're buying Munjaro.

SPEAKER_02 36:30

Yeah.

SPEAKER_01 36:31

You know, with we're and the patient assistance programs and the copay programs work well for everybody. But pharma companies would be great to partner with them because we'll tell the story. You know, we'll we'll make sure that they're on the front page standing next to us and the mayor of Trelloc saying, look what we're doing in Trelloc, you can do it in your communities as well.

SPEAKER_00 36:53

And it as you said, it's difficult for many to navigate those programs or to even find them at times. Um we've gone as far as we've created a website called the Advocate Bridge. And on the advocatebridge.org, you have all of the disease state nonprofits that are out there. So you can put your diagnosis in and it shows you all of those organizations that are available for you. But then on the financial side, we link to all of the company-based uh you know uh patient assistance programs or branded patient assistance programs.

SPEAKER_01 37:32

And they're incredibly wonderful programs because they really do people, help people. Sometimes it's a little challenging maneuvering it, sometimes they challenge, sometimes they change by the month. But at the end of the day, um you can really get help and if you look for it. And if you don't, and and the sad part is it's not always easy, if but if you keep at it or if you get questions, um I can say to your viewers, my office phone number is 209-250-2315. Feel free to call me and I'll help you.

SPEAKER_00 38:12

That's fantastic. That I mean that for many patients, as you said, for that one that uh got her product through your pharmacy, that's the difference between food for their family or not. Or rationing medications or not.

SPEAKER_01 38:26

Or pain for yes. Or pain for us. Yeah.

SPEAKER_00 38:29

Yeah. And these are the social determinants of health that it seems in the last 18 months we've forgotten.

SPEAKER_01 38:37

I think I think a lot of entities talk about the social determinants of health. And you can talk them to death, you can write about them to death. You know, I like to say that let's determine what the first one is and work on the first one. And figure out how you can connect it to the second one, et cetera, and how you can do certain things. You do as much as you can with what you have to work with in a way that's beneficial and heartwarming. Sure. You know, at the end of the day, to me, it's all about the smile. It's it's whether it's your face smiling or it's your heart smiling.

SPEAKER_00 39:18

I I absolutely love that. That's why I got into this world and got into patient advocacy as well. It's it's for that smile tells you more than you'll need to know about what their future looks like. Because you can just tell you've completely changed their life.

SPEAKER_01 39:36

Yeah. And you know what? And you get to go to sleep at night thinking about that. Or you wake up in the morning, which is okay, where am I going to get the smile today? And sometimes what soup's on the menu. Well, that's exactly right. I'm going down to footers and you know, to call the Michael, hey, what's the soup today? Or not. Or going down and getting my you know humongous diet code for them and telling them and reminding them, as I did last Thursday, you know why I come here? Because you are the nicest, kindest people on the face of the planet. And when I walk in here, everybody, you're all smiling. If you're putting hot dogs, you're doing this, you're doing that. You can't buy that smile. And for me, it's energizing.

SPEAKER_00 40:15

That's fantastic. Uh you know, we you talked about why you do it. How do you explain to other people who ask what you do what you do?

SPEAKER_01 40:27

Um, I explained that I build and fund healthcare solutions.

SPEAKER_00 40:35

That's a very succinct, clear example.

SPEAKER_01 40:38

And then just take it from there and say, let me give you an example. And they generally get it if they're listening. They don't always get it. And they kind of and if they're curious, they'll ask more questions.

SPEAKER_00 40:53

What do you think is most misunderstood about philanthropy or the nonprofit space in general?

SPEAKER_01 41:00

What's most misunderstood is that many of the nonprofits know how to operate.

unknown 41:09

Okay.

SPEAKER_01 41:10

That you're giving money to something without really understanding how well they operate. Or, for example, I'd want to know, use a federally qualified healthcare center as an example. What benefits does the C-suite get that the rest of the staff don't get?

SPEAKER_02 41:29

Yeah.

SPEAKER_01 41:30

You know, is there a deferred benefit, a deferred comp plan? Is there a car, a free car? Is you know, what benefits are they getting that I don't get? You know, same thing. Yeah. Um and then, you know, what's their admin costs? You know, we cap it at 17% you can use for admin. Wow. And, you know, can you live within those boundaries? And nonprofits are wonderfully inspired entities that philanthropists need to not and they do this, uh, pick up the cover and look underneath it, but also dissect it. But sometimes you have to be brave enough to invest in the person pitching you. It's a nonprofit, but the person doing the pitch is amazing. You know, there's a nonprofit in Patterson, California, which is west of here, called Invest in Me. And the young woman who runs it used to work for a large insurer, decided to leave there and just do this full time. We invested in her because she's so amazing. And then her sister joined her to run the nonprofit. And they do such amazing work for young women. Um, that you every time they call, it's like, how do you say no? Or how do you say no to a pastor on the west side of Turlock who makes sure that kids have after-school programs and are fed and have clothes and have shoes. And it's not about her, it's about the people that she serves. And Dr. Jolyn de Grazia does this amazing work, does a Christmas show, uh, local volunteers, and the woman teaching dance is just this. Hillary does this incredible job. Um, and they come together for a single purpose to give these kids not only a sense of what could be, but a sense of self. That you can do this. And my response is okay, then how do we help you?

SPEAKER_00 43:41

It's it's funny you say that. It's exactly why my wife danced uh started her dance program. She started her dance studio because it was all about instilling confidence in the kids in the local community. It's dance and theater, and you can just watch these kids' whole outlook on life change. Once they've been on stage.

SPEAKER_01 44:02

Oh, absolutely. And that's the best part. I mean, and they remember it. Oh, yeah.

SPEAKER_00 44:08

Yep. Uh you know, you talk about partnering with industry, and you know, as you may well know, I benchmark industry and their work with organizations like yours. I mean, it's a no-brainer to me to be working with an organization like yours. Because really all that we hear is the need to have the metrics and the value of the spend. Right? And that is something that I'm hearing as you reference, not every nonprofit knows how to do that. But it's something that's been ingrained in you. Where did you learn your administrative spot style and the way that you operate?

SPEAKER_01 44:53

Um, a combination of graduate school, law school, asking questions.

SPEAKER_00 45:00

Good. I didn't hear your undergrad. That's fine. For those who aren't familiar, Jeffrey is a grad of the school up north, as we call it, from Ohio State.

SPEAKER_01 45:12

Yes, the University of Michigan. Yes. But then I went to the University of Southern California that were until they joined the Big Ten. Now you join the Big Ten. And then law school somewhere else. You know, um, you pick up a lot of it. I picked a lot of it up by um different jobs I've had and asking questions. And I was blessed with some CEOs in the private sector who would you know spend an hour every once in a while and taking questions and answering them. Um and then you just, as you dive into the nonprofit world, you learn real quickly, or the for-profit world, um, what's the return on investment? Where are the key performance indicators?

SPEAKER_02 45:56

Yeah.

SPEAKER_01 45:57

Um are these terms that people don't understand or are not using? Or how do you say to a new clinic, well, what's your what's your where's your business plan? And you know, there is no business plan. And then you give them a consultant to build a business plan, but they don't embrace the consultant. And you have two choices. You either shove it down their throats, but you really have to make them successful because you've invested in this, or you say, Thank you very much, you finished the year and weigh goodbye. And they look there, you know, and they don't understand. And well, you explain to him or them what happened. Um it's a learning exercise. There's uh you know, I'm not an MBA type. I'm a guy who wants to have conversations and listen and learns more from you telling me, and I'll ask you a thousand questions and hopefully you'll be kind enough to answer them. But the other way I do this is I hire smarter people. I always have. I like to find people who are much smarter than I am in specific areas like my controller and Wendy off the charts are amazing. Our finance manager, Stephanie, same way, you know, challenging, encouraging, our whole team. Um but if you don't hire people that are smarter than you, it's really stupid. It's like shame on you. Because, you know, when I was when I was in Congress as a staff director, I would always hire the ones that were smarter. And they knew they were smarter. Sure. They didn't know I was a sponge. So they would, you know, they come in, you as a human sponge, you gather all that, you soak it in yourself. Okay, I figured this out, let's go on to the next one. And you find the next really smarter person. And you build a team based on those kinds of things, and that gives you greater success. Are you going to make a faux pas here and there? Absolutely. Are you going to be the football? Yeah. But you learn from that and you keep asking the same or different questions to continue the exercise.

SPEAKER_00 47:57

How do you yeah, if I was starting a nonprofit, let's just say, or maybe we're speaking to any of the nearly 20,000 U.S. disease state focused nonprofits today? They're dealing obviously with a very tough economy. They're doing their fundraising. But what maybe one thing would you tell them to focus on the most right now in this last half of 2026?

SPEAKER_01 48:24

Why aren't you combining your organization with three or four others? Single operation for a disease states. Why should why should one disease state stand alone? Why aren't you focused on four or five that come together? Someone's going to be in charge. You maximize dollars. Because your donors at some point, whether it's a philanthropy or a private donor, is going to be looking at where these checks are going like, why are we doing this?

SPEAKER_00 48:50

Yeah. That's an amazing point because we can't, I can't tell you the number of times I've seen we're going to build X because everyone builds X, and then you're recreating the wheel over and over and over again. But then you also run into situations like we saw in diabetes where we got legislation passed that you can't do non-med switching, right, or or formulary controls because of a change in insurance for a patient with diabetes, but that stopped at diabetes. You know, because I But they are starting to do it now.

SPEAKER_01 49:27

Well, they they did it two years ago, and the Munjaro went from was fifty dollars a month for the year. That was the whatever the coupon was. They changed that. So in October, the insurer comes back and raises it to 100. Now I I call them very kind. I called the PBM and said, well, you can't do this. And you know, I filed a protest and I called my broker. And they weren't ready for that. And they apologized and then extended the $50 for another year. But the following year they raised it back up. If you don't challenge the system by at least making a phone call and trying to challenge, it's really a shame on you. There's always somebody out there who will help you do this. But you know, think of the Medicare population. So insulin is what, $35 under Medicare? But that's only for insulin. So your typical diabetic has got multiple comorbidities, and they're paying more than $35 in some cases for those other drugs. Yeah. So no one's looking at how much they're paying in totality for that cocktail, plus the if they're taking, you know, if they're injecting insulin every day and what they're paying for the you know the different tools that they need, plus the DEXCOM. Hey, say, shout out to the DEXCOM people. I sent a letter to the guy who's the CEO, never got a response. It's okay. But you know, that happens, and you look for some other company that wants to partner with you or some other nonprofit.

SPEAKER_00 50:56

Well, Jeffrey, I'll put this on myself and I'm gonna put it on record. I'm speaking next week with both Eli Lilly and Dexcom. Cool. So I'll bring it up. Cool.

SPEAKER_01 51:07

Because these organizations are we could be Eli Lilly's best poster child for helping the community with the with not just the cost of just insulin, but more importantly for the Moonjaro program, which I am a user and think it's done a phenomenal job.

SPEAKER_00 51:23

Yeah.

SPEAKER_01 51:24

But Dexcom, the challenge that they face is at what point uh will there be another product out there like uh ABIT has, you know. Yeah. And why aren't people just switching from that? Because it's a equally great product and less expensive.

SPEAKER_00 51:44

Yep. But and and one of the things that you have done with the the diabetes clinic that you've created is also address one of the biggest barriers to care with a CGM, which is the education piece. And so you know, coming back to uh may it be convergence of nonprofits or the healthcare issues of the day, you went to the community, you talked to them, and you listened. So novel.

SPEAKER_01 52:16

You know, there's certain things you learn in politics from from great politicians. I've worked with one, two, three Republican senators who promoted the idea of doing town hall conversations. Uh and I worked with the last Republican governor of Oregon, where we would go out and do these meetings, no press, but just with families to talk about something. And they were no press. No press. No, no. That was not because second term you couldn't run again. But it was more important. You didn't need the press there to tell the story. You wanted the families there to that, he wanted to understand more about why you are why you have taken care of 500 foster kids. And and tell me about that. And they were, you know, amazed, in some cases, in tears, that their governor wanted to know.

SPEAKER_00 53:10

Sure. And they were going to use that story, I'm sure, at some point, right?

SPEAKER_01 53:16

It's a good story to tell. It's not typically most politicians still do today. You know, you can still see the politician you're having a conversation with, and he or she's looking over your shoulder to the next person, you know.

SPEAKER_00 53:28

Yeah.

SPEAKER_01 53:29

And you can't teach them how not to do that. You can just try.

SPEAKER_00 53:33

Yeah. Yeah. As you look towards the future, obviously state Medicaid programs are going to have some major challenges as you you laid out for California. What are you hoping to see from the nonprofit world, but also in politics, to address these issues of patients losing access to health care?

SPEAKER_01 53:56

You know, I think at some point we need to, on the Medicaid side and Congress first, is to decide that every child in America should have access to healthcare and level the playing field. Irrespective of income, irrespective of immigration status, and every child born in this country has access to the a state Medicaid program with multiple benefits. It takes them out of their parents' health insurance plan, lowers the cost for the employer, and now the employer is providing health insurance coverage for the adults. Let's recognize that children's health care is our future. That we want that child before he or she is born to be as healthy as possible. We want that child to be vaccinated. And yes, I'm pro-vaccine. And we want that child and that family to sort of strive and survive and be healthy and to have access to whatever that child needs. So as they grow older into a teenager or into an adult, they're not ten steps behind the curve because they were on Medicaid. Every child should be in a state, a national platform. It's not what Bernie Sanders talks about in terms of nationalizing health care. It's a very different approach. It's simply saying every child, we treat every child the same.

SPEAKER_00 55:21

Including prenatal care.

SPEAKER_01 55:24

Everything from primary care to hospitalization to long-term care. No parents should ever have to frick where they need they have a severely disabled child with services in the home that they can't afford it. You take it off the table. A child is a child, regardless of his or her health status, that we take care of them. And then we worry and we do that for X number of years and build a database and show how it's impacting families, use a general accounting office like they used to be used to really look at these things.

SPEAKER_00 55:55

Yeah.

SPEAKER_01 55:56

And plan. That's the future. If we don't do if we don't take care of kids, there is no future.

SPEAKER_00 56:04

Any advice to patients that may be caught up in the paperwork shuffle when it comes to their state?

SPEAKER_01 56:13

It's the worst shuffle to be in. It's demoralizing, it's demeaning. But if I can help, 209-250-2315, give me a call. I may not be able to, but you know what? I'm happy to help and help you understand where other resources are like you, like Brandon McSada, like others who really are dedicated to helping people do this.

SPEAKER_00 56:39

That's fantastic. You know, I'd imagine that in your career you've gotten both A, some great compliments, and B some great advice. What do you feel is the best piece of advice that you've ever been given?

SPEAKER_01 56:56

There are three things. Always listen before you talk. Always recognize that that could be you who you're talking to. And accept the blessings that come with you and around you. And there embrace them, they're non-denominational, and never be afraid to pray with anybody.

SPEAKER_00 57:35

I love that.

SPEAKER_01 57:36

Yeah, what I love about Turlock is it's multifaceted in its religions, in its ethnicity, and its culture. And you learn to respect and to honor every culture. And most importantly, when you listen to those cultures, you learn things you wouldn't have thought about before. And that's a great life benefit that you can't buy.

SPEAKER_00 58:06

Yeah. On the flip side, what's the best compliment you've ever received?

SPEAKER_01 58:13

I had a former board member who just sent me an email that basically said, thank you for everything that you're doing, that you have done, and that you will be doing. And we never thought we could have all this here. And we do. Now, what are you going to do next? So it's a wonderful compliment, but it's also a challenge to look forward. Um and I'm about, I'm all about looking down the road. It's not for another job, it's really about what's that challenge, what's that opportunity, where where can you be more creative or creative in a different kind of way? And I would end by saying that the most important lesson I've learned ever is to always say thanks. Because this is a really wonderful thing that you're doing. Uh we discovered each other, we had a long, probably an hour and a half talk that you thought was probably going to be 25 minutes. Yeah. And we just kept talking. Yeah. But you know, I firmly believe when I you know I write these poetry books.

unknown 59:32

Yeah.

SPEAKER_01 59:32

This is the this is the current version of the book. That's the one I got. Yeah. And I wrote a column about what is love? And they published it in a true like paper, and people like, you know, you get about three responses. You know. And but I thought about instead of writing about healthcare, I would pivot over here and write about something else because I think about it a lot. And, you know, to basically say to other people, you could do this. I just happen to sit in a cigar bar and it takes me eight or nine months to write one of these things. But it's there's nothing we can't do to change healthcare if we're determined to do it. May take a little bit longer, but we take great pride in what we do, and most importantly, that it's a team. It's not one person. Yeah. Um, it's the team of people you build around you.

SPEAKER_00 1:00:27

And you guys have done it extremely well. Truly a model, I would say, for the rest of the country to take a look at. You have said it's it's a petri dish, so to speak, of you know, both the folks that are there and the opportunities that are in front of you, right? The challenges that most people would see, but you see them as opportunities. And I want to get you involved in a discussion that I've been having with Gary Cohen, who was responsible for um uh uh implementing ACA at a state level. He uh was on the board of Blue Cross Blue Shield of California, which is the the odd bird of Blue Cross Blue Shields, you know. Um and we've been thinking about this how do we change healthcare? And I think your model is a very interesting one to run with. And quite frankly, his original thought was Medicare. And trying a different Medicare model for a small population. But I think yours in children is the bigger impact longer-term opportunity.

SPEAKER_01 1:01:41

You know, giving families access to children's hospitals as an example and never worrying about the cost. Yeah. Well, you can say to the Danny Thomas hospital, you know, in the South, where they do this phenomenal work, and every other hospital that does the same, every other children's hospital. If a family can walk in and never worry about the cost, it you know, the relief is enormous. But we're using dollars to hire the very best brains to care for people. And it's very true. I mean, to me, it's a it's a pretty simple equation. If we aren't focused on our future, which are children, the born and unborn, yeah, then it's really shame on us.

SPEAKER_00 1:02:27

Yeah.

SPEAKER_01 1:02:28

As a guy who's growing older every day and never gonna have hair again, hey, you know. Yeah. It's a great program. And and I will say, as a as a proud bald man, I don't want it again, man. You you got great hair, you can have it. I hate it. Well, you can hate it, but you know, not this guy.

SPEAKER_00 1:02:48

Well, Jeff, it's been an unbelievable conversation. My my last question for you is the last question I have for everyone. If you could go back to your 20-year-old self, what would you tell them?

SPEAKER_01 1:03:03

I would tell them never give up on anything, especially love. You will eventually find it, and that woman or man will will always be with you either in your heart or next to you. Without you never lose them. Yeah. And you it's hard to teach a younger person that. I think the thing to remember is this there is no tomorrow without them.

SPEAKER_02 1:03:48

That's fantastic.

SPEAKER_00 1:03:49

Well, Jeff, I really appreciate your time. Thank you so much for the work that you're doing, both for the patients of Turlock and the people of Turlock. But the ideas and the creativity that you bring to healthcare in vital need. So thank you again.

SPEAKER_01 1:04:05

Yeah, it's an honor, and whatever I can do to help you, just ask. Remember, 209-250-2315. I'll answer the phone.

SPEAKER_00 1:04:12

You know what? I'm gonna write this one down because I don't know if I have it. 209.

SPEAKER_01 1:04:16

209 250 2315. Now the best part, it flips right to my cell phone when I don't answer it.

SPEAKER_00 1:04:25

There you go. Well, Jeff, I appreciate it.

SPEAKER_01 1:04:29

Happy to do it. Thank you so much.

SPEAKER_00 1:04:31

Thank you.