Q&A: Jack Hooper, Take Command Health

Jack Hooper is the Founder and CEO of Take Command Health. Prior to co-founding Take Command Health, Jack  was  a  strategy  consultant  at  the  Boston  Consulting  Group  and  an  intelligence  officer  for  the  FBI  and  CIA.  Jack twice received an innovation  award  from  the  Director  of  the  FBI  and  was  awarded  for  distinguished  service  overseas  by  the  Director  of  the  CIA. 

In this Q&A, Jack discusses the foundation of Take Command Health, legislation he is hoping to see in future sessions, and the impact a new round of  Individual Coverage HRAs will have on the market. 


Emily Viles: Tell me a bit about Take Command Health. How did you start the organization?

Jack:  Take  Command  Health  stemmed  from  personal  headaches  and  frustrations  dealing  with  the  healthcare  system. Several years ago, my wife and I were living on a graduate student budget when we were surprised with a twin pregnancy. It was very exciting but also left us with a lot of questions. I had taken out student loans to cover the expenses, but trying to figure out how much twins was going to cost was just impossible.

It was around the same time the Obamacare, the Affordable Care Act, was rolling out and while it is exciting that there was going to be an insurance market, if people cannot figure out how to shop for it wisely and how to make good decisions with it, it does not do much good. I could not even get close to figuring it out.

This is really our origin. Trying to solve that problem personally, and then it turned  into a school project, a research project and then Take Command Health actually launched as an independent insurance market. Our first project was sort of like TurboTax for health care, showing you a bunch of options, showing you through the process and guiding you to make a good insurance choice.

Emily: Has Take Command Health transformed since then? Have you taken on new projects or changed your central mission at all?

Jack: Yeah, it really has. In the last two years we have really started to look at the small group market and getting into the defined contribution models. A law that passed early in 2017 that started the QSEHRA, that allows small businesses to reimburse tax free for insurance instead of purchasing traditional group plans. What we really like about it is, that, one, it is a fundamentally different insurance model. When you think about the group plan model, it used to make sense because it was really the only way to get insurance. Now there is a stable market, and it feels kind of antiquated.

We think that employers should override tax free dollars and pick a plan that they want you to use. So, we have really jumped on QSEHRA and helping employers set up and manage it. We have built some pretty cool technology around it where employers can see any receipts right on there phone. But then we still have our individual shopping platform which is fundamental to our mission to help empower employees and individuals to make smart insurance decisions.

So, if your company is not going to provide you a plan, but is instead going to give you a certain amount of dollars every month, we can turn that around and say let’s go find a plan with your doctors and prescriptions to find you a plan that helps you get the coverage you need but also spend the money wisely.

Emily: Are you the only group in the market providing this service, or is there a similar model that has followed?

Jack: Right now, we are all alone. We have a lot of great HRA providers. There are a lot of great individual insurance providers. As far as we know, we are the only ones that put those two together to create a solution. We think that some of these new regulations that have come out will see more people get into this market because it is expected to grow much larger.

Emily: Based on some of our previous conversations, I know that you are spending your mental energy on the new HRAs. Can you tell me a bit about some of that work, and your involvement there?

Jack: We have put a lot of time and energy into this because we really believe in the model. When you think about group health insurance, especially small group insurance, anywhere from under 300 lives, we push this as a thing that is working. Politicians do not want to touch it, business do not do much with it. There is an idea of negotiating as a group to get a better deal.

But, when you look at the history of premium increases over the last decade or so, small group has just been steadily marching up. I think that it is fair to take a step back and say, “hey, is this working?” You have to look at it and say no.

Larger groups, sure it is working, they have more resources. But if you are a small group, a 5, 10, 20, 100-person employer you are not getting better deals. Why is that? Fundamentally the law is backwards.

If you think about your experience with group plans, your employer picks it out for you as a benefit, and then you take your card and see the doctor, and close your eyes and hope that months later you get a bill that represents what you thought it should be.

We are not really empowering employees, we are setting them up for failure. When you think of the defined contribution model, there is a lot of concern that it puts more stress on the employee. We want to empower the employee so that when they go to the doctor they already know who is in-network, what the copay should be.

We get so excited about this model because we really think that it has something new and different to offer and can help get employees in the game.

Emily: Do you think that one of the biggest challenges with these new HRAs is just the fact that people do not know that they exist?

Jack: Yes, education is a huge issue. People just assume status quo and now we are in year seven or eight of the ACA, and people who are new to the market are finally just catching on to how it works. But it takes time. I think it will be the same with the new HRAs, but it could go faster is market conditions break that way.

Emily: Do you think that if the ACA was repealed it would have an impact on these new HRAs?

Jack: Definitely. The HRAs rely on a stable, individual market and that is where group plans came from. In the political sense it is a bit ironic. HRAs have seemingly had bipartisan support. The first one QSEHRA was the last law signed by President Obama, and then President Trump has done a lot to expand HRAs with his new regulations. It has encountered very little resistance from Democrats. We think that it is pretty universally agreed upon that employers should be able to support employees with insurance, it is just that they buy the plan for them or give them money to go buy the plan.

The irony is that, like you said, in order to expand HRAs you need a stable market. And I know there is a perception that he in undermining it, or taking steps to weaken it and that is a debate for another time. There are projections that these new HRAs could actually double the size of the individual market which would bring even more stable.

For the State of Reform audience, thinking about where things are going, if Republicans and Democrats do agree on the HRAs then they have to work on stabilizing the individual market. The lawsuits that threaten the ACA’s individual market could undermine the HRA approach

Emily: Were there any bills this session that you had your eye on? Any that you hope to see in future sessions?

Jack: Specifically in Texas, we have been excited about some of the transparency bills. And the surprise medical bills as well. It is exciting that these issues are getting that level of attention. We hope to see it go a step further in future sessions. Specifically in transparency we hope that data is reported in a way that is consumer friendly. And, then in terms of surprise medical bills, it was a great start, but it only applies to individual plans, not group plans. In order for it to really make an impact in the market it would have to include those group plans.

Emily: At the federal level is there anything that you are watching?

Jack: Yeah. We are eager to see how these new HRA regulations are implemented. We have the finalized rules but it all starts in 2020. We just got IRS rules to help clarify this, and we are keeping a close eye on that. And, obviously, with the election, it feels that any major health care issues are on pause for the election, so we are waiting to see what happens there.

Emily: Is there anything else that our readers should know?

Jack: People should know that we are really excited about this new model of insurance. I think that there is the potential that these new HRAs catch people by surprise. You might look back in 5 years and wonder what will happen to the group market. On the insurance side, the ACA changed a lot of things, but insurance is pretty slow to adapt. There are often not a lot of new things that appear, but this could really be one.

I know that the State of Reform audience has a lot of great engagement from the clinical side, from the provider side, and patient care, I hope that insurance can enter the forefront of reform discussions. For better or worse, it really is the way that most Americans access the system. If they are confused by it, then we are already off to a bad start.