EP305: The 1% Most Expensive Claimants Racking Up Massive FFS Bills and Still Not Getting the Help They Need From Our Health Care System, With Darrell Moon, CEO of Orriant

In Episode 305, Stacey Richter talks with Darrell Moon, CEO of Orriant, about the 1% most expensive claimants who rack up massive fee-for-service bills year after year without ever actually getting better — and what behavioral science reveals about why.

WHAT YOU'LL LEARN

✅ Why the same high-cost claimants keep reappearing year after year without improving

✅ How loneliness and low self-esteem drive some patients to become "hyper-users" of health care

✅ Why a perverse incentive can form when someone's identity becomes wrapped up in their health issues

✅ How to distinguish a true hyper-user from someone with a legitimately complex chronic condition

✅ Why building self-esteem, not just adding more medical appointments, actually improves outcomes for this population

WHY THIS MATTERS

Darrell Moon and his team at Orriant noticed that certain high-cost patients kept generating expensive care year after year without ever getting better — and traced it back to loneliness, low self-esteem, and low self-efficacy that no amount of specialist visits could fix. When someone's identity becomes their myriad of health issues, they can develop a perverse incentive not to follow medical advice, since getting better would mean losing that identity. Helping these patients requires behavioral science, not more tests, and it means asking two simple questions to identify future high-cost claimants early: how's your health, and how's your social experience?

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:11 What do CEOs want out of the health care system?

04:52 Is it a good strategy to focus on high-cost claimants?

07:04 Who are the people year over year that wind up in the high-cost claimant pool?

07:50 "Really, you have to get to the crux of the problem, which is … they've become a victim … to the health care system."

08:16 Who are these "hyper-users" and how do we define them?

11:35 "Getting that person to have a regular relationship with someone isn't the hard part; the hard part is then helping them to build their self-esteem."

13:20 "That's the key to building self-esteem—is helping people accomplish what's most important to them."

14:57 Why helping a patient not to view themselves as a victim helps them manage their care better.

17:45 "It's often less the training and the right personality of the person."

18:54 Do health outcomes correlate with the self-esteem of the patient?

19:28 "If you want to identify future claims, ask people two questions: 1) Tell me about your health … and 2) Tell me about your social experience."

21:21 "They're the customer/owner of their own health."

24:23 "How do you help not just the 1% but everybody [in health care]?"

27:16 "The ideal environment is to have a massively powerful primary care team."

27:47 "Having an influence on that person and what they do and how they behave is more important than getting the diagnosis right."

29:34 "It's not about just when [people] reach out … but [getting] people to reach out early."